Identification

In advanced MS, when physical disability limits activity and confines an individual to wheelchair or bed, deficits in cognitive function can be more difficult to discern. Increased sleepiness, physical inability to hold a book to read, or not participating in family life fully make it difficult to assess attention and concentration, memory, reasoning, executive function, multitasking, or visual and spatial orientation.

The only obvious clue might be the effect of cognitive dysfunction on mood, where frustrated thinking or poor decision-making results in anger and withdrawal. Decisions must be analysed for logic, realism, and feasibility of implementation. It is not uncommon for those with advanced MS to make unhealthy and illogical decisions regarding their own care— firing a personal assistant abruptly or stopping a medication against doctor’s orders. Refusing care, or imagining care needs inappropriate to the situation, can occur.